Healthcare Provider Details

I. General information

NPI: 1194658757
Provider Name (Legal Business Name): SALLY SALDIVAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 K ST
BRAWLEY CA
92227-2736
US

IV. Provider business mailing address

1141 K ST
BRAWLEY CA
92227-2736
US

V. Phone/Fax

Practice location:
  • Phone: 760-909-8961
  • Fax:
Mailing address:
  • Phone: 760-909-8961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number743035
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: